Case Study

Introduction

The symptoms present in patients experiencing gastrointestinal (GI) conditions are often non-specific, and it is important for care providers to conduct an extensive assessment to identify the underlying cause of the presentations. This process is further complicated by the fact that GI manifestations can occur on the background of diseases involving other systems. For example, patients with serious migraines frequently present with vomiting and nausea (Elliot et al., 2018). Hence, assessment of GI symptoms should be thoroughly performed on all system for both an accurate diagnosis and the appropriate therapeutic intervention. The paper will assess a case study involving GI manifestations, establish a diagnosis and rationale, and a treatment plan for the patient.

The case presents a patient with nausea, vomiting, and diarrhea, which are non-specific gastrointestinal symptoms. The patient has a confirmed history of drug abuse and suspected hepatitis C. However, the latter can only be placed as a diagnosis following a polymerase chain reaction (PCR) that identifies HCV RNA in the serum (Altaf et al., 2019; Ferri et al., 2016). Therefore, based on the medication history, the patient is suspected to be experiencing complications from the use of prednisone. NURS 6521 week 4 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

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The side effects of prednisone on the GI tract have been well documented in scholarly literature due to their use in the management of different conditions. For example, patients that have been prescribed this drug have been found to have an elevated production of gastric acid within one month (Resanen, 2016). Furthermore, corticosteroids adversely impact the gastric mucosa, which further increases the risk of gastritis or gastric ulcers. These phenomena can be better understood through the mechanism of action of prednisone. This involves inhibition of phospholipid conversion to arachidonic acid, which stops prostaglandin production and its gastro protective functions (Caplan et al., 2017). This makes the gastric wall susceptible to the physiologically acidic pH of the stomach, leading to the manifestations displayed by the patient.

The general principles applied to minimize the side effects from oral glucocorticoids include a reassessment of their use and necessity for the patient, reducing the duration of use, and providing mucosal protective agents such as bismuth subsalicylate or sulcrafate. These agents help in coating areas of ulcers or erosion and preventing further damage from gastric acid. In the case of this patient bismuth subsalicylate will be selected agent as it also contributes to stimulating the secretion of mucus, prostaglandin, and bicarbonate (O’Malley, 2020). Patient education will also be provided, and include information on diet and different products that should be avoided while taking prednisone. Spicy and fried foods are not recommended, and smoking and alcohol should also be avoided as they irritate the gastric mucosa. The patient has a history of drug abuse, which makes education on abstaining from alcohol important as this can lead to ulcers, and gastric perforation, which is life threatening.

Summary

The paper discusses a patient that reports with non-specific gastrointestinal manifestations, a history of drug abuse, and currently synthroid, nifedipine, and prednisone. The preliminary diagnosis of the patient is gastritis on the background of prednisone use. This is a glucocorticoid, which affects the gastric mucosa through inhibition of prostaglandins. The drug bismuth subsalicylate was prescribed due to its mucosal protective properties. Other recommendations such as patient dietary education were also stated as certain food products can also affect the state of the mucosa and cause the existing manifestations to persist or lead to more life threatening situations.

References

Altaf, S., Tarar, A., & Naeem, N. (2019). Current Status of Therapeutics and Diagnosis of

HCV. BioScientific Review (BSR), 1(2), 01-12.

Caplan, A., Fett, N., Rosenbach, M., Werth, V. P., & Micheletti, R. G. (2017). Prevention and

management of glucocorticoid-induced side effects: a comprehensive review: a review of glucocorticoid pharmacology and bone health. Journal of the American Academy of Dermatology, 76(1), 1-9.

Elliot, S. Y., SS, Y. P., & Venkatesan, T. (2018). Migraine, cyclic vomiting syndrome, and

other gastrointestinal disorders. Current treatment options in gastroenterology, 16(4), 511-527.

Ferri, C., Ramos-Casals, M., Zignego, A. L., Arcaini, L., Roccatello, D., Antonelli, A., … &

Lamprecht, P. (2016). International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmunity reviews, 15(12), 1145-1160.

O’Malley, P. A. (2020). Pink Prescribing: Bismuth Subsalicylate; History, Actions, Risks,

and Future Use. Clinical Nurse Specialist, 34(2), 45-47.

Rasanen, T. O. I. M. I. (2016). Some aspects of the humoral mechanism of gastric

secretion. Gastric Secretion, Mechanism and Control, 255.

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

 

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Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

To Prepare

• Review the case study assigned by your Instructor for this Assignment
• Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
• Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
• Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

By Day 7 of Week 4

Write a 1-page paper that addresses the following:

• Explain your diagnosis for the patient, including your rationale for the diagnosis.
• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting. NURS 6521 week 4 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.